Provider Demographics
NPI:1184722837
Name:AUSTIN, KATHERINE (PA)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1479 W LACEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5906
Mailing Address - Country:US
Mailing Address - Phone:559-583-4617
Mailing Address - Fax:559-583-4625
Practice Address - Street 1:1251 DRAPER ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1934
Practice Address - Country:US
Practice Address - Phone:559-897-6610
Practice Address - Fax:559-897-6611
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010606363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid